Cancer Doctors Prescribing Fewer Opioids Since Opioid Crisis Interview with:
Joshua Kra, MD
Assistant Professor of Medicine, Rutgers NJMS
Division of Hematology/Oncology
Rutgers Cancer Institute of New Jersey at University Hospital What is the background for this study?

Response: We aimed to characterize pain management practices by medical oncologists to assess whether CDC guidelines from 2017 for nononcologic settings changed prescribing patterns for oncologists. What are the main findings?

Response: There was a significant decrease in opioid prescriptions from medical oncologists starting in 2017, which coincided with the recognition of the opioid crisis as a national public health emergency and the publication of CDC guidelines for opiate prescribing in non-cancer settings. This would suggest these factors contributed to how oncologists changed their management of opioid prescriptions for cancer patients.

Opioid Prescriptions by Surgeons for Post-Op Pain Relief Decline, but Progress Has Slowed Interview with:
Kao-Ping Chua, MD, PhD
Susan B. Meister Child Health Evaluation and Research Center
Department of Pediatrics, University of Michigan Medical School
Ann Arbor MI 48109

Dr. Kao-Ping Chua
Dr. Kao-Ping Chua What is the background for this study?

Response: Surgery is one of the most common reasons for opioid prescribing. Ensuring the appropriateness of opioid prescribing by surgeons is important, as prescriptions that exceed patient need result in leftover pills that can be a source for misuse or diversion. Although there have been numerous recent policy and clinical efforts to improve opioid prescribing by surgeons, recent national data on this prescribing are unavailable.

In this study, we analyzed a comprehensive prescription dispensing database that captures 92% of prescriptions from U.S. pharmacies. From 2016 to 2022, we found that the rate of surgical opioid prescriptions at the population level declined by 36%, while the average amount of opioids in these prescriptions declined by 46%. As a result of these two changes, the total amount of opioids dispensed to surgical patients declined by 66%.

However, there were two caveats:

First, the decline in surgical opioid prescribing was most rapid before 2020 and has slowed since then.

Second, the average surgical opioid prescription in December 2022 still contained the equivalent of about 44 pills containing 5 milligrams of hydrocodone, far higher than most patients need after surgery.

Some Headaches May Really Stem From Neck Muscles Interview with:
Nico Sollmann, M.D., Ph.D.
Resident in the Department of Diagnostic and Interventional Radiology
University Hospital Ulm, and the
Department of Diagnostic and Interventional Neuroradiology
University Hospital Rechts der Isar in Munich, Germany What is the background for this study?

Response: Neck pain is very common among patients with primary headache disorders, such as tension-type headache or migraine. However, neck pain is mostly neglected during diagnosis as well as for treatment concepts in patients with such headache disorders. 

Our study revealed alterations of the trapezius muscles in subjects with tension-type headache and subjects with tension-type headache plus migraine attacks by using quantitative magnetic resonance imaging. We suggest that those changes (i.e., increase of T2 values of the trapezius muscles) may be related to subtle edematous changes within the musculature, which might stem from inflammation. . What are the main findings?

Response: Given that we also found significant associations between those muscular changes and the number of days a subject suffered from headache over the 30 days prior to imaging as well as neck pain, our study may provide objective evidence for the interrelationship between the neck area and the brain in headache disorders What should readers take away from your report?

Response: Primary headache disorders may be linked to neck pain, and quantitative magnetic resonance imaging may help to visualize and objectify changes of neck musculature that might be related to subjectively perceived pain. Involvement of neck muscles in primary headache disorders may relate to subtle inflammatory alterations in muscle tissue. What recommendations do you have for future research as a result of this study?

Response: The application of quantitative magnetic resonance imaging can objectively detect changes of the trapezius muscles in subjects suffering from headache disorders, thus providing a quantitative biomarker. Such a biomarker has not yet been available, and it could be used to phenotype patients, monitor the disease status, as well as treatment effects.

In a planned randomized controlled trial, we would like to combine quantitative magnetic resonance imaging (for diagnostics) with peripheral magnetic stimulation (for treatment) to provide a comprehensive framework combining a novel treatment approach with therapy monitoring. Such a trial could help to elucidate effects of peripheral magnetic stimulation by an objective method that is targeting the neck musculature in headache disorders, thus providing the possibility to potentially relieve muscular pain and headache.

No disclosures. The study has been published as an open-access article in the meantime for more detailed information. (


  1. RSNA 2023 abstract:
  2. Sollmann N, Schandelmaier P, Weidlich D, Stelter J, Joseph GB, Börner C, Schramm S, Beer M, Zimmer C, Landgraf MN, Heinen F, Karampinos DC, Baum T, Bonfert MV. Headache frequency and neck pain are associated with trapezius muscle T2 in tension-type headache among young adults. J Headache Pain. 2023 Jul 12;24(1):84. doi: 10.1186/s10194-023-01626-w. PMID: 37438700; PMCID: PMC10337094.

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Acupuncture and Massage May Be Part of Pain Management Plan in Patients with Advanced Cancer Interview with:
Jun J. Mao, MD, MSCE
Chief, Integrative Medicine Service
Laurance S. Rockefeller Chair in Integrative Medicine
Memorial Sloan Kettering Cancer Center What is the background for this study?

Response: Most of the pain intervention trials focused on cancer survivors who completed treatment or patients in hospice care, little is know how these treatments work in patients living with advanced cancer. With the improvement in cancer treatment, many people are now living with advanced cancer but suffer from pain from their cancer or treatment.

Since acupuncture and massage have been found effective to manage pain in other populations, we designed this study to compare the effectiveness of these two interventions for musculoskeletal pain among patients living with advanced cancer. We hoped these results will aid patients and their doctors to make informed decision in pain treatment.

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Rutgers Study Finds Modest Decrease in Non-Prescription Opioid Use with Cannabis Legalization, But Concentrated in People Addicted to Cannabis Interview with:
Hillary Samples, PhD, MHS
Assistant Professor of Health Systems and Policy
Rutgers School of Public Health
Core Faculty
Center for Pharmacoepidemiology and Treatment Science

Rutgers Institute for Health, Health Care Policy and Aging Research
New Brunswick, NJ 08901 What is the background for this study?

Response: Early studies suggesting that cannabis legalization is associated with lower rates of opioid-related harms received considerable media attention. At the time, overdose deaths were driven by prescription opioids, and medical cannabis was often framed as a policy approach to address the opioid epidemic. However, as research in this area grew, the relationship between medical cannabis legalization and opioid-related harms became less clear. Many studies of cannabis legalization were unable to examine opioid use by individual people, and individual-level studies outside the legal context showed links between cannabis use and higher risk of opioid-related harms. Thus, our goal was to build evidence of the relationship between medical cannabis legalization and individual-level opioid use.

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Chronic Pain Extends Beyond Mere Physical Symptoms Interview with:
Dahee Wi, PhD, RN
Department of Biobehavioral Nursing Science
University of Illinois Chicago
College of Nursing, Chicago, Illinois What is the background for this study?

Response: Chronic pain, defined as persistent or recurrent pain lasting longer than three months, is a significant health problem, particularly among U.S. active duty service members (ADSM). ADSMs are at an elevated risk for chronic pain due to the nature of military service and related job training. Chronic pain is a leading cause of disability and medical discharge in the military, significantly impacting readiness and mission capabilities.

Chronic pain is often accompanied by multiple comorbid conditions, making it essential to view it not just as a single symptom but in relation to co-occurring symptoms of other conditions. The study conducted network analysis, an analytic technique that provides graphical representations of the relationships between selected measures. This approach can offer new insights into the complex interplay of physical, emotional, and social factors in chronic pain

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WashU Study Surveys Cannabis Use for Sleep Interview with:
Carrie Cuttler, Ph.D.
Associate Professor
The Health & Cognition (THC) Lab
Department of Psychology
Washington State University What is the background for this study?

Response: We know that one of the top 5 reasons cannabis users report using cannabis is for sleep disturbances, but we don’t know very much about the types of products they prefer to use for sleep or their perceptions of its effects and side effects relative to more conventional sleep aids (e.g., benzodiazepines, antihistamines, melatonin).

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CAMH Study Finds Potential Risks to Baby from Cannabis Exposure During Pregnancy Interview with:
Maryam Sorkhou
PhD student at the Institute of Medical Sciences
University of Toronto What is the background for this study?

Response: While studies on animals strongly suggest that exposure to cannabis during pregnancy can affect brain development, the impact of using cannabis during pregnancy in humans is not yet clear. Some studies suggest potential negative effects, while others find no impairments.

In light of increasing trends towards legalization and potentially decreased perceptions about the risks of cannabis, our meta-analysis of 57 studies aimed to fill this gap by exploring the associations between prenatal cannabis use and birth and childhood outcomes.

Study Finds Any Physical Activity, Even Sleeping, Is Better than Sitting for Cardiovascular Health Interview with:
UNIVERSITY COLLEGE LONDON Can you provide more insight into how much more beneficial moderate to vigorous activities are compared to light activities or standing, in terms of measurable health outcomes?

Response: Our study suggests that the best activity that you can do for your heart is moderate-vigorous activity, followed by a trio of common daily activities: lighter activity, standing and sleeping, with sedentary behaviour being the most harmful. There was a very large and strong association between spending more time in moderate to vigorous activities and better heart health outcomes (outcomes included: BMI, waist circumference, HDL cholesterol, HDL: total cholesterol ratio, triglycerides and blood glucose levels).

For example, replacing 30 min of sedentary behaviour with moderate to vigorous activity was associated with 0.63kg/m2 lower BMI (or –2.4cm lower waist circumference). If an individual were to replace the sedentary time with 30 minutes of light activity instead, we would expect to see a ~0.5 kg/m2 lower BMI. And if an individual replaced their sedentary time with 30 min of either standing or sleep, we would expect to see a ~0.4kg/m2 decrease.  These difference in benefits was much larger when considering cholesterol and triglyceride outcomes.

It was notable that heart health benefits are likely to be observed after replacing just a few minutes of sedentary/sitting time with moderate to vigorous activity. However, to achieve comparable benefits with standing or light activity, it could require 1-3 hours of replacement depending on the outcome (slightly less for measures of obesity such as BMI, much more for cardiometabolic blood biomarkers like cholesterol or triglycerides).

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Study Finds False or Misleading Claims Not Uncommon Among Ketamine Prescribers Interview with:
Michael J. DiStefano, PhD

Department of Clinical Pharmacy
Skaggs School of Pharmacy and Pharmaceutical Sciences
University of Colorado Anschutz Medical Campus, Aurora What is the background for this study? What is ketamine primarily used for?

Response: Ketamine has been an FDA-approved anesthetic since 1970. However, it is increasingly used off-label to treat a variety of mental health and pain conditions. Some providers also offer oral formulations of ketamine, which do not have FDA approval for any indication. Esketamine, an enantiomer of ketamine, is a nasal spray that recently received FDA approval and is narrowly indicated for people with treatment-resistant depression. Esketamine has an extensive FDA REMS (Risk Evaluation and Mitigation Strategies) protocol in place to promote safe use. There is no analogous safety protocol in place for the off-label or unapproved use of ketamine.

Given increasing interest in using ketamine to treat a variety of conditions, we were interested to see how the drug is being promoted to potential patients. The FDA typically regulates consumer advertising for prescription drugs, but only for manufacturers, packers, and distributors of these drugs, designations which don’t seem to include these clinics. The FDA requires that consumer drugs ads are accurate and provide balanced information on both benefits and risks.

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